Organization
ESTEBAN D. BONILLA DDS PROFESSIONAL CORPORATION
Active
Other names
Cosmetic Implant Gold Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ESTEBAN D BONILLA D.D.S. (DENTIST / OWNER)
(818) 980-2887
Entity
Organization
Contact information
Practice address
10745 RIVERSIDE DRIVE, SUITE B, TOLUCA LAKE, CA 91602
(818) 980-2887
(818) 980-2807
Mailing address
10745 RIVERSIDE DRIVE, SUITE B, TOLUCA LAKE, CA 91602
(818) 980-2887
(818) 980-2807
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
36135
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B36135
MEDI-CAL PIN
CA
Enumeration date
07/19/2007
Last updated
07/19/2007
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